26 ORNE ST - BUILDING INSPECTION f
The Commonwealth of Massachi R.UTTIONAL SERVIL a
sh Board of Building Regulations and Standards 3ALEOI
Massachusetts State Building Code, 7�N 30 P 2- 2
.. _ ::.�, Revised Mar 2011 i
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Divelling
This Section For Official Use Only j
QO Building Permit Number: Date Ap
NBuilding Official(Print Name) .Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
C 1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(In
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (bLO.L c.40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public❑ Private❑ M
Check if yes❑ [3unicipal On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 ,p wner of Recur:
1 � O 1t I'co^-C
Name(Print) J City, State,ZIP
94? D reLz S -f `Y 8—7V S- L/F3 8
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ I Accessory Bldg. ❑ Number of Units I Other ❑ Specify:
Brief Description of Proposed Work'': J4 -54 g•It IT �— 59 a-5:k oh 914— rQ Wr!
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
I. Building $ a. 9 v 9 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $.
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees:$
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ 1D.. 9 Q ❑Paid in Full ❑ Outstanding Balance Due:
I'Y► ra��,� 3j31
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
t Gl ri S 2&,-z* License Number Expiration Date
Name of CSL Holder Z S A10/ ` I
5i List CSL Type(see below) vl
No. and Street Type Description
U Unrestricted(Buildings u to 3d,000 cu. ft.)�,
R Restricted 1&2 Family Dwelling
City/Town, State,ZIP M Mason
ry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2AA Registered Home Improvement Contractor(HIC)
Ff"d 6{ S2tri CeS �nC - LD1o09 l0 2{i—)r
HIC Registration Number Expiration Date
HIC Company Name or 1-I IC Registrant Name
e ny O tit. 5——`
No. a M 10
nd Street Email address
� L�w,
City/Town, State, ZIP Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject property,hereby authorize rl/i y t S G o✓2
to act on my behalf, in all matters relative to work authorized by this building pennfit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNERS OR AUTHORIZED AGENT DECLARATION
By ermring my name below, 1 hereby attest under the pains and penalties of perjury that all of the information
M
is a lication is true and accurate to the best of my knowledge and understanding.
V MAR 2 5 2016
Print Owner's or Authorized gent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at
www.mass.2ov/oca Information on the Construction Supervisor License can be found at www.mass.Lov/dps
2. When substantial work is planned, provide the information below:
Total floor area(sq. ft.) (including garage, finished basement/attics, decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
'A� p Zi A & A SERVICES, INC. V V
set
8' &A SERVICES 115 NORTH STREET,SALEM,MA 01970
VIMOW WM Telephone: (978)741-0424 Fax:(978)741-2012
Contractor Registration No. 101609
Federal EIN:04-3090162 Construction Supervisor No.CS057733
ROOFING SPECIFICATION SHEET
Buyers)Name Date of Contract
60Zhs lc�e' M792C
Buyer(s)Street Address,City,State and Zip Code
2 (u 021U5- ST Silt " ItII9 0/970
Daytime Telephone Number Evening Telephone Number Mobile Telephone Number E-Mail Address
978-7vS—y828
The Seyer(s)listed above hereby dir uy and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described on
this Specification sheet and the front and the reverse of the accompanying CUSTOM REMODELING AND IMPROVEMENT AGREEMENT,of which this Specification
Sheet Is a part.
ROOFING SPECIFICATION
Strip Roof of# 77,(J O layers of shingles
K t-tati
`I)Install 6'of ice and water shield at base of roof where Install 16-64ek-papef,-to roof.
possible. Install 18-24"of ice and water shield in valleys.
®Flash chimney as-al(no repointing included). Install 6'perimeter drip edge to rakes and fascia areas.
`,,PAAInstall vent pipe boots and seal as needed. 'P Flash valleys as needed
/}'ilnstall rollout type ridge vent. T Planks/plywood replacement under 32 SO FT included,
'If more is needed there will be an extra charge of$70,
per hour for labor plus the cost of materials.
Dumpster/Disposal Included: t Other: C 0L-04—
Location: Da J vy-lN✓;-�
Install new roof: Manufacturer F— CT—yr Style/typefb e-L41 iTt/>Z-/YL
Included in this proposal are thorough cleanup, building permit,and company/manufacturer warranties.
RUBBER ROOFING SPECIFICATION
°t Strip Roof It Not Strip Roof
I' Install 1/2"High Density Fiberboard to existing roof using f Flash obstacles as needed.
screws and plates.
1 Install .060 membrane EPDM(Black) rubber roofing to `r Install 3x3 aluminum drip edge to perimeter of roof with
fiberboards seam tape.
It Flash up sidewall as needed.
Included in this proposal are thorough cleanup, building permit, and company/manufacturer warranties.
SPECIAL INSTRUCTIONS:
fC-779/L Pr r Gig /qi t/U r/ '—
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0s�csvn�Frtr��r= �/z, 9o9 w
AVv /'m2cw-rs oat /SS,
It Is agreed and understood by and between lM1e partles that this Spe cation SM1eet,along with CUSTOM REMODELING AND I ROVEMENT AGREEMENT,conslltules
cip
the entire understanding between the partles,and there are no verbal understandings changing or modifying any of the terms. This contract may not be changed or Its
terms motllfled or varied in any way unless such changes are in writing and signed by both the Bayonet and the Contractor. Buyers)hereby acknowledge that Buyerts)
hea read this Specification Sheet.
Contractor Initials: `dF1VD Date Buyer's Initials: _ Date k 3 O/C
,, /� c�'p`, ��+ A & A SERVICES, INC.
AsIA JGI\Y �W 115 NORTH STREET, SALEM, MA 01970
• `• Telephone:(978) 741-0424 Fa,: (978) 741-2012
Contractor Registration No. 101609
Construction Supervisor No.CS057733
Federal EIN: 04-3090162
CUSTOM REMODELING AND IMPROVEMENT AGREEMENT
Su ems) Name Data of Contract
472c- 3 -, -/
eu er(sl Street Address,City.State and Z12 Code
0—Y1 S- L&Vni 1111,14 0/570
Daq imre�Tele hone NULmbre�r n EveningTele hone Number Mobile Telephone Number E-Mail Address
— /C/36
The Buyers)listed above hereby jointly and severally agree to purchase the goods anchor services listed on the accompanying specification sheets,in accordance
with the prices and terms described an the font and the reverse of this agreement and any specification sheets(this`Agreement"),and Buyems)have requested
that such goods m servme5 be installad ar provided atat Buyer's address listed above.ASA Services,Inc,("Contractor"),hereby agrees to install Or Cause to be installed
the products or services listed in this Agreement at the Buyers)address vrtitten above.This Agreement represents a cash sale of goods and services.The Boyers)
agree to pay in cash the cost of the goods and services purchased as described herein,regardless of timing or approval of any financing Buyems)may seek for their
purchase. O
Purchase Price: ? f0?, Est.Starting Date. 'IS
Down Payment N 3 C'O Est,Completion Date' -30-1
Cash
Amount Due on Start of Job: Check
Credit Card
Amount Due on of Completion: N 11
o.
Amount Due on_of Completion' [� Expiration Date.
Balance Due on Upon Completion 8&09f
CVC Code:
It is agreed and understood by and between the parties that this Agreement, front and back and any addendum, constitute the entire
understanding between the parties, and there are no verbal understandings changing ar modifying any of the terms of Nis Agreement.Stymie)
hereby acknowledge that Buyerfs)has read the front and the reverse of this agreement and has received a completed,signed and dated copy of this
Agreement,including Me also attached Notice of Cancellation forms;on the date first written above.Buyer(s)also(1)acknowledge that they were orally
Informed of their right to cancel this transaction;and(11)request thetthey be contacted via their telephone numbers or email,as listed above,In the event— --'
Contractor believes Buyers)would be interested in any additional quality products or services of Contractor.DO NOT SIGN THIS CONTRACT IF IT
CONTAINS ANY BLANK SPACES.
A&A S r— 'ces Inc Buyer(s)
By:
Signature
av�u, x na�
Print Name Print Name
Signature
Print Name
You,the Buyer(s), may cancel this transaction at any timel prior to midnight of the third business day after the date of this
transaction. See the following Notice of Cancellation form for an explanation of this right.
ARBITRATION:The contractor and the romeoxnerisereby Norally agree in advermland in Ne event offer party Iles a dispute coneming this anduc,either party may subrvl such dispute lox
private amended,service added has been approved by Ne summary of the Entrustss Mom of ConsumerAffairs and sureness RagWaoons and the other party shall be required to social Us Such
ardersom as pmd d m MG.L c14 A 'i
Con mnorin-1- Y.� Mot, Initials:
tot.: -/2-/6 in,
r� -
NOTICE OF CANCELLATION /p NOTICE OF gANgELLATION
Dale al Transaction 3_/8_/6.Tour may wnml Nls iransacbw,vnMo.any penelry or Date o1 Transaction��(U—�.�You may cancel this t oreover A bwl any penalty or
obluabon,whom three business days from me above data if you cancel,any propepuaded in, ebbgauoa whom Mme business days from the above date.llyouwncel,anypmptin'tidenum.
any Ponds,made by you under Ne contract at sale.and any negotiate instrument eaecutM any foundation aside by you under Me Corona or sae,and any negotiate imbutrent executed
by you.11 be relomad WNm 10 days follo,nng receipt by Ne Seller of ynur cencelvoi defeat by you All determined each 10 days Iollov ing receipt by the Seller of your biomlatim notice.
and any Primary Interest among out or Me Miami will be cancelled.II you cancel,you must and any securely interest am9ng out of Me transatl m will be eanMled.11 you once,you most
make available to Me Seller in your residence,and subsunfally in as good—drum es Men make available he he Seller at your resonance.and substarselly in as gone mndies,as when
procepred any goods delivered to you under gas Cursors or Sale;or you m3y,it you southeasterly received,any goods dereved to you under Nis Contour or Sale:or you may ifywvach,craddly
w.N the Phenomena of Me Seller regarding the"Mum
shlpmeni of Me goods at the Sellers Yen Me instructions
ons at Me Seller regarding Me re sNp're id Me goods at Me Sellers
nt
expenx and nsk.If you ll do make Me gas frodribe,to the Seller and the seller does not antl expense and risk.If you do make the gases available b Me Seller and Me Seller does not pick
Mom op women 2C days of Me dale of your None a eaacenaron.we Trey roteid or Pspam of the Main up world 20 days of he dater your Notice of Generators,you nay ream at dispose of
goods wiNON any turner obligation.If you fall to make me goods revelate to Me Seller,or it you Me goods vaout any turner chimeras If your tall to Make the goods available to the Seller,or if
agree to return Me goods to the Soler all fail W do so,then you remain liable for performance of you agree to reWm the goods to the Seller and fall to do so,Men you remain liable for performance
toM.galions under he Cmtpvo.To Faced this foundation,mail ar deltvtt a signed and dated of all obligations Under Me Cenuad.To cancel this transaction,matt Odurvera signed and dated
copy or the mnmllamn made or any Prier actual receive,Orsend a telegram to ABA Sery 1e mpy of Me oncellafon no5m or any orer willhan nOfce,m send a delays q8q Services,
115 North Street Salem MA 01970,NOT LATER THAN MIDNIGHT OFvf-21—/f�. Ill hand Street Saam MA 01910.NOT UTER7NAN MIDNIGHT OF r5 m6/—/(e
m and mnwh
I HEREBY CAXLELTHIS TRANSACTON I HEREBY CANCEL THIS TRANSACTION
Consumers 5ignamre Date: Consumers 5ignahure Oale:
The Commonwealth of Massachusetts
Department of Industriol A ccidents
}� Office off vestigat1011S
600 Washington Street, 7" Floor
_ ? Boston Mass. 02111
Workers' Compensation Insurance Affidavit: Building/Plumbing/Electrical Contractors
Applicant information: Please PRINT legibly
name: ��`✓L5-/?,a —ze;rzy.
address' 2 e4
city 6' a 12 stale: MA D,, zip: /970 phone#
work site location(full address): Q&- Of� :J0-/KM Mil g-70
❑ I am a homeowner performing all work myself. Project Type: ❑New Construction ❑Remodel
❑ I am a so le proprietor and have no one working in any capacity. ❑ Building Addition
F 1 am an employe r r poviddinng workers' compensationQ for my employees working on thisjob.
company name: 4l'"- ,14- Q('s-V I �.2$� f Al
address: � l g5- .t\,/O ✓ 4 i�l J 4-, n p [ + /
city' Sa i--e�((n��" -71-��� phone#: -I 2O - 7 �Q'�p0L W-7
insurance co 1 WC_ b la I✓e I-e r tS policy# ��C� t°✓/� to 1 5 _
❑ I am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
company name:
address:
city: phone#:
insurance co policy#
company name:
address:
city phone#:
insurance co policy#
Attach additional sheet if necessary
Failure to secure coverage as required under Section 25A of:\ICL 152 can lead to the imposition of criminal penalties ofa fine up to S1,500.00 and/or
one years'imprisonment m well as civil penalties in the form of it STOP wOR Iv Olt DER and a fine of S100.00 it day against me. I understand that a
copy of Ih is statement may be to rwanled to the ffice of Investigations of the DI:\for coverage verificatimt.
_..
/do hereby cerlifj�urtr a (h pain s nor/p "oh, s of perjury(hn!the infonttnlioo provider[«Gave i
Signatur� 1 / Date ')gyp
Print name �/1/ C 7-00 / LO✓Zs—/ Phone# O 7 O 7 1 v 7
t
official use only do not write in this area to be completed by city or town official
city or town: permit/license}! ❑Building Department
❑Licensing Board
❑check if immediate response is required ❑Selecnnen's Office
❑ilc lth Department
contact person: phone#; ❑Other
: Imvisea Sept_2003t
�J�O Phone: 978-741-0424
sz-mix Fax 978-741-2012
ies.com® &A SERV' 115 North Street s Salem, MA 01970
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of M.G.L.c.40, Sec. 54, a condition of Building
Permit Number is that the debris resulting from this work shall be
disposed of in a property licensed facility as defined by M.G.L.c. 111, Sec. 150a.
The debris will be disposed at: Waste Management 877-515-2845
c/o Melrose Transfer Station
740 Broadway
Melrose, MA 02176
or
Waste Management, Dumpster Service
at
115 North Street
Salem, MA 01970
C w IV`Y
Signature of Pp rmit Applicant
Christopher Zorzy, President
Name of Permit Applicant
Date
certificate No: A044298
THE COMMONWEALTH OF MASSACHUSETTS
TI_ -iyi EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT
l DEPARTMENT OF LABOR STANDARDS
7t n;
� 19 STAN(FORD STREET,BOSTON,MASSACHUSETTS 02114
DELEADER CONTRACTOR LICENSE
A&A SERVICES, INC.
115 NORTH STREET
SALEM MA 01970
I
i
LICENSE: DC000440 EXPIRES: Saturday,June 25,2016
IN ACCORDANCE WITH M.G.L. CH. 111, § 197B(b)AND 454 CMR 22.03, THIS LICENSE IS ISSUED BY
THE DEPARTMENT OF LABOR STANDARDS TO THE CONTRACTOR ABOVE FOR THE PURPOSE OF
ENTERING INTO OR ENGAGING IN DELEADING WORK.
I
I
i
THIS LICENSE IS VALID FOR A PERIOD OF ONE YEAR.
i I
THIS LICENSE MUST BE MAINTAINED BY THE CONTRACTOR WHEN ENGAGED IN DELEADING
WORK IN ACCORDANCE WITH M.G.L. CH. I I I § 197B(b)(2) AND 454 CMR 22.03.
i
I
WILLIAM D.MCI{INNEY,DIRECTOR
Massachusetts -Department of Public Safety
r 'C..nu..i.....
�. .OfGce of Consumer Aftairs&Business Regulation ; Board of Building Regulations and Standards 1
'HOME IMPROVEMENT CONTRACTOR C"''t"' ""' if,
` Re istration: 101609 Type: License: CS-057733
la M g
r(Expiration: 6/26/2016 Private Corporatio s
' CHRISTOPHER 2;b
PIE 4&A SERVICES, INC tlf 115 NORTH ST � ' wo$ r_ 1
1 a Salem MA 019707
Christopher Zorzy
115 North Street ��' .6..-->6.� '`t
Salem, MA 01970 Undersecretary Expiration
jCommissioner 05/26/2017
I I
iA&A SERVICES, INC.
115 NORTH STREET
!SALEM, MA 01970
. 30 � C� Lq,�n
� 8""` `inlvl Phone: 978-741-0424
�� HWC11% SERVICES Fax: 978-741-2012
"'s w .a-aservices.com
2111b MAR 30 P 2 26 115 North Street
Salem,MA 01970
March 25, 2016
City of Salem
Building Dept.
120 Washington Street
Salem, MA 01970
To Whom It May Concern:
Enclosed please find the permitapplication for George March, 26 Orne
St., Salem, MA.
I have enclosed a check f" or$91.00 based on your fee schedule of $7.00
per $1,000.00. The job was/$12,909.00..
Please send the completed permit to A & A tServices, Inc.-at 1�15 North
Street, Salem, MA 01970. /
If you have an4uestions,��please contact me at (978) 741-0424.
Thank yowfor your assistance.
Sincerely,
Sincerely,
f
Barbara Zorz
Office Manager